Former Competitive Runner Dealing with Fractures from Osteopenia/Low Bone Density

Triathlon Forum
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I’m a former competitive runner that has been dealing with fractures (on and off tibial stress fracture and more recently, lumbar compression fracture) for the last year. I used to run competitively, but stopped ~2 months before onset of symptoms (this was about a year and a half ago). I was diagnosed with osteopenia via DEXA Scan, but subsequent urine and blood labs haven’t found a cause for the low bone density. I’m a 29yo male, so there’s not a lot out there on this for my demographic.

Have done lots of research into the different medication options (biophosphonates, Forteo, Prolia), but endocrinologist didn’t think they were appropriate given my age and lack of any other known underlying issue. From my own research, I understand there are big drawbacks to each at my age, but hoping to get a good professional perspective from a metabolic bone specialist I’m seeing in July. My bone health has clearly gotten much worse over the last year (vertebral compression fracture was completely non-traumatic), so I understand I need to be very proactive and that might mean medication.

Trying to stay positive and proactive throughout this ordeal and appreciate that there are far more worse things affecting people, but I’ve been an extremely active person my entire life so very frustrated and want to at least get back to pain free daily activities. Including a bunch of additional info below, and really appreciate any thoughts or suggestions!

Timeline of symptoms:

Ran up to 90 miles per week throughout college (ran 1500m and 5000m at NCAA D1 level, so this included lots of fast/intense running, strength training, etc.) without any bone issues (but plenty of soft tissue injuries, nothing unusual for that level of running though) After college, started to have bone stress injuries running substantially less (40 – 50 miles per week), including 1 x tibia stress reaction and 3 x femoral shaft stress reaction (all diagnosed via MRI) – these are not uncommon running injuries, so doctors weren’t overly concerned, and all healed fine - looking back, I think these were early signs of declining BMDStopped running completely in March 2018 to let other injuries heal and take a breather from the grind of competitive runningStarted feeling stress fracture-like pain in May 2018 after a short hike, MRI showed bone stress injury to tibia, so DEXA scan was ordered, which showed osteopenia (scores of -1.9 and -2.4 for femur and spine, respectively)Was referred to endocrinologist and labs (blood, urine, 24 hour urine) all came back fine (full metabolic panel, calcium:creatinine ratio (24 hour urine), PTH (parathyroid hormone), magnesium, phosphorus, CMP, tissue translgutaminase, and endomysial AB)Tibia pain resolved and was completely pain free from July 2018 to September 2018; started to have occasional pain October 2018 to January 2019Pain worsened in February 2019 and MRI showed tibia injury was still thereAs I was having pain walking, have been on crutches for majority of time since March - have been trying to ween off, but it’s been a long processPerhaps most concerning, I started having bad back pain a few weeks ago. Just received MRI results that confirmed a compression fracture in lumbar vertebrae - waiting to get more detail and will be getting referral to a spine specialist. Fortunately, the pain has started to get a bit better.
Other details:

I’m 6’2 and ~170 lbs - have always been very thin (in college was even lighter), and I understand that is associated with lower BMDTaking Cal/Mag/D, Multi, Boron (helps with calcium absorption), and Cissus Quadrangularis (plant-based supplement that promotes bone health – figured it couldn’t hurt) dailyDiet is good – plenty of fat, protein, fruits/veggies (no dietary issues noted in labs)Limiting alcohol (2-3 drinks per week)Have been seeing a physical therapist for the last couple months, mainly to try to understand pain patterns (have been on/off crutches so no strengthening yet)Found out I was mildly lactose intolerant in late high school and didn’t have dairy from 18 – 25 before reintroducing dairy w/o any notable issues. Bone issues seem to coincide with reintroduction of dairy into diet, but doctors haven’t thought that an issue from labs, so maybe just coincidental.Traveling to see a metabolic bone specialist in July that has experience treating young people with low bone density

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Well, have you tried getting your weight up first…? I too have been suffering similar with my weight dropping too low

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Interesting post. Although my running volume was never that high, I’ve had almost the exact issues you have starting when I was 37 or 38. Several atypical fractures eventually led to an osteoporosis diagnosis. I did do a month of Forteo to heal the fractures that never seemed to get to 100% on their own. I’ve worked with an endocrinologist for 5 years now to get to the bottom of it, but still no answers. Basically, I’m just lucky, and it sounds like you are, too. You’re doing everything right. It was my diagnosis that led me to quit triathlon and start cycling exclusively, with strength training and a whole ~8 miles/week of running.

What I’ll say is that I have not suffered a single overuse-type injury cycling and it has been awesome. So be patient and get healed up, then reset your plans accordingly.

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Sorry to be a bit of a downer, but as a medical specialist myself slow twitch is probably not the correct forum for the high level advice you need for what is going on with you.
If you want to vent about how much this sucks then by all means, just be very careful about what advice you receive in these types of forums. Unless you are dealing with a specialist in early onset osteoporosis then the advice you receive may be questionable and make future treatment discussions more difficult as well.

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I can share my history which may or may not be relevant. I was severely anorexic from ages 13-18. I was diagnosed with osteoporosis in my spine and osteopoenia in my hips at age 17 in 2004. From roughly October '04 to April '05, I went from 93 lbs to 115. I’ve since stayed 115-122 lbs (I’m 5’6") and in Feb. '19, my bone density scan indicated a 10% improvement in bone density. I’m back to normal hips and an osteopoenic spine. (I’m 32). The improvement for me was from (1) maintaining a healthy weight for a very long period of time and (2) birth control pills. I lift weights occasionally - far less than I should.

Bisphosphonate meds seemed like a good solution 10 ish years ago but more recent studies have shown mixed results for the long term; I think you’re right to avoid them.

Cliff Rosen is one of the leading researchers about osteoporosis in the country. He is based in Maine (or was 10 years ago). He’s who NASA calls to ask what will happen to astronauts’ bones. He does research and has a medical practice in Bangor, ME (or used to). So if you were going to get an outside consult, I’d try to get your records sent to him.

Anyway, if I were you I’d lift some weights and maybe try to gain some weight (as unappealing as that might be).

Keep us updated, please. Good luck.

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Thank you all for the helpful replies - much appreciated.

I’ve asked several doctors about my weight (including an endocrinologist), but they don’t think it’s problematic given my diet. I’ve been lifting more since the initial diagnosis, but can’t currently given my fractures - agreed that needs to be part of the long-term solution though.

I understand the perspective that I should be working with professionals on this and am doing that. I’m traveling to see Dr. Paul Miller in about a month (leading metabolic bone specialist, and among other things, has experience treating young athletes - see: https://www.sciencedirect.com/science/article/pii/S1094695018302002). I’m also working on setting up a remote consult with Dr. Keith McCormick, a chiropractor and former Olympic pentathlete who overcome severe osteoporosis to get back to triathlon (he’s written a book many have found very helpful: https://www.amazon.com/Whole-Body-Approach-Osteoporosis-Strength-Harbinger/dp/1572245956). I will plan to see how things go with Dr. Miller, but will keep Dr. Rosen in mind as another option.

Again, really appreciate everyone’s responses. This is a difficult situation, but I’m trying to stay optimistic and be as proactive as possible.

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I fractured my Pelvis at ~30 years old with a simple fall. Post FX DEXA revealed Osteopenia.

I went on Forteo for 1 year and saw a relevant increase in bone density. The risk here is Osteosarcoma which is why, I believe, they limit to 1 year.
Bisphosphonates are seemingly to be bad news and (as said before) probably worth avoiding.

Regarding other methods to increase density: Obviously weight lifting and other activities with significant load bearing (such as plyometrics) can be beneficial. Additionally, non-cyclical movements: e.g. Soccer with it’s multi-planar movements is beneficial whereas running (being cyclical) is not.

Supplements: MK7 seems to be an emerging recommendation to drive the deposition of calcium into bone. Strontium supplementation seems to increase bone density over calcium, but I do not believe we know if practical strength is increased.

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I don’t think you particularly underweight. I am your height and 175 lbs and have swimmers shoulders and arms and still have some obvious fat around the middle. In my teens and early twenties I was 155-160 when I was running a lot not nearly as much as you though. I don’t think wt is a factor in your case but listen to whoever you are seeing.

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I saw the bone specialist last week - very helpful visit and extremely glad I made the trip.

He spent a long time with me going over my medical history, and brought in a few other doctors at the practice for their take as my case seemed so unusual.

He ended up ordering some additional bloodwork (IFE and PE Serum, Prolactin, Osteocalcin, IGF-1, Free and Total Testosterone, Propeptide Type 1 Collagen, Celiac Disease Panel, C-Telopeptide, and Bone Specific Alk Phosphatase), and pending the results, potentially doing a bone biopsy to better understand the nature of my low bone density (not building enough new bone, breaking down bone too quickly, etc.).

We discussed treatment options (mainly Forteo and Tymlos), but he wants to have as much information as possible before making a decision so we’re going to wait for the test results (and potentially bone biopsy results).

My pain is very slowly improving and I’m continuing to ween off the crutches (recently spent a full week off them before needing them again), and I’m really encouraged with the path I’m on.

Appreciate everyone’s help and support, and feeling optimistic that I’ll have a meaningful path to improvement soon.

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Hello,
I know this is an old post but was wondering how your situation I going. I am in a similar position that you were in (scary actually how similar) fine running 90 miles a week for 6 years the when on reduced mileage developed stress fractures that would not heal. also traveled to see a bone specialist that works with young athletes. any updates or advice to look into. Currently awaiting another week to get more blood tests as the specialist thought I was taking too much calcium and want me to not take nay supplements for 1 month to get a fresh test.
Hoping you are doing well!

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If it weren’t for email notifications I would have never seen your note… overall, I’m doing a bit better but not where I want to be yet.

Since posting here several years ago, I’ve made the rounds across different medical specialties via referrals and second opinions – at this point, I’ve seen several endocrinologists, metabolic bone disease specialists, orthopedic surgeons, PTs, chiropractors, and even an orthopedic oncologist. Lots of different (sometimes conflicting) opinions and recommendations, which was tough to navigate (the US health care system doesn’t exactly facilitate collaboration…)

Ultimately, I did a year of Forteo followed by ~6 months of Fosomax under the care of a fairly renowned metabolic bone specialist who wasn’t able to find a clear secondary cause for my low bone density, but thought pharmaceutical intervention was necessary. My bone density in my hips returned to normal, but my bone density in my spine actually decreased a bit and my leg pain persisted.

On a hunch (and not agreeing with diagnosis of stress reaction/fracture from others after reviewing my imaging), an orthopedic surgeon had me tested for compartment syndrome in my leg. My scores were right at the threshold for surgery, so I had that done about 6 months ago. My pain improved a bit since then, but I think most of the improvement has been from pressing reset and going through PT.

Today, I still have pain walking more than several blocks, but I do light weight lifting + core for 30 min every day, bike a small amount (mainly for transportation), fairly intense PT session once a week (currently doing a lot of jumping/bounding), surf or swim once/week, and have introduced very light running once or twice a week over the past few months. WFH has allowed me to structure my life around maximizing activity and minimizing pain, which has been a silver lining around the pandemic.

It’s not sure what’s next, but staying positive and trying to be thankful for the things I am able to do.

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…wow, what a cluster f*ck you have to deal with, for so long! You seem to have a great attitude staying positive. Hopefully, your body will change back to your running days some day…
Good luck and all the best,
U